Addiction

Considerations when developing a teaching plan to address adolescent addictive behaviors 

• Self-Management and Recovery Training ( SMART Recovery ) is a support program for people with addictions and behavioral disorders. It teaches people how to control their addictive behavior by focusing on underlying thoughts and feelings. The four-point program includes the following: 

• 1. Enhancing and maintaining motivation to abstain 

• 2. Coping with urges 

• 3. Managing thoughts, feelings, and behaviors 

• 4. Lifestyle balance (balancing momentary and enduring satisfactions)

Lithium in the treatment of gambling addiction 

impulse control

Behavioral addictions

Internet gaming addictions, sex addictions, shopping addiction, and exercise addiction 

Chronic effects of alcoholism

• Affect ADLs, employment, nutrition 

• Liver damage (cirrhosis) 

• GI bleeding 

• Pancreatitis 

• Cardiomyopathy 

Signs for alcohol abuse

For DSM-5, meet at least 2 criteria over 12 months. Tolerance, withdrawal, neglect of responsibilities, cravings, and continued use despite problems.

CAGE-AID

4 question tool to assess alcohol or drug use 

• Have you ever felt you should Cut down on your drinking or drug use? 

• Have people Annoyed you by criticizing your drinking or drug use? 

• Have you ever felt bad or Guilty about your drinking or drug use? 

• Have you ever had a drink or used a drug first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? 

CIWA

Monitors alcohol withdrawal severity 

CAGE assessment tool 

• Cut down (do you ever feel you need to cut down on your intake?) 

• Annoyed (about drinking) 

• Guilty (about drinking) 

• Eye opening  

• Any positive response needs further investigation 

• CAGE AID – alcohol and substance 

CIWA assessment tool 

• Know that you are scoring the withdrawal symptoms

   

• Benzos are the best to use for withdrawal  

Signs of alcohol withdrawal

• Tremors, cramps, emesis, inc temp/BP/pulse, seizure, headache, visual/tactical hallucinations, and delirium tremens 

• can begin as early as 2-4 hours after the last beverage is consumed and peak between 24 and 48 hours. Symptoms may continue for 4 to 7 days. 

Wernicke-Korsakoff Syndrome and Vitamin B1  (thiamine)

Progression of Korsakoff’s syndrome where there is a deficiency of thiamine due to chronic alcohol use.

Symptoms include neurologic findings, such as hemorrhagic degeneration of the brain. It carries a death rate of more than 15% of those diagnosed. 

Clinical manifestations of cocaine use

Immediately following use, individuals may experience increased feelings of strength, sexual arousal, and decreased or absent appetite. Side effects include increased heart rate, increased blood pressure, and increased motor activity. Observed symptoms are dilated pupils and paranoia. Undesirable effects include hallucinations, with reports of “bugs crawling” and sense of foul odors. 

• Death from cocaine is the result of hyperthermia due to prolonged seizure activity. Tachycardiac arrhythmias and coronary artery spasms have also resulted in death from cocaine. 

• extreme weight loss and malnutrition, myocardial infarction, brain damage, and stroke 

• • Constricted pupils 

• • Drowsiness 

• • Decreased vital signs 

• • Slurred speech 

• • Psychomotor slowing 

• • Initial euphoria followed by dysphoria 

• • Impairment of attention, judgment, and memory 

Substitution therapy to treat a client for opioid addiction 

Methadone for opioid addiction 

Reversal meds for opioids and benzodiazepines 

• Benzos: Flumazenil (flumazocon) 

• Opioids: Naloxone  

• Alcohol: Disulfuran (deterrent to consumption of alcohol that causes bad side effects if you drink) 

Indications of readiness to change 

Precontemplation → Contemplation → Preparation → Action → Maintenance 

Risk factors for developing addictions 

• • Genetic predisposition to addiction or exposure to alcohol prenatally 

• • Inadequate parental supervision 

• • Racism 

• • Lack of economic opportunity 

• • Poor self-image, self-control, or social competence 

• • Lack of employment and neighborhood poverty 

• • Peer-group behavior 

• Adverse childhood experiences:  

• • Physical, sexual, or emotional abuse and neglect 

• • Witnessing violence in the home (partner or parent) 

• • Substance misuse or mental illness in the home 

• • Parental separation or incarcerated household member 

Serotonin pathway and dopamine pathway

• Cocaine and amphetamines act on the dopamine and serotonin systems, producing an intense rush followed by intense lows, reinforcing compulsive use. These two drugs also share the same receptors and are cross-tolerant. 

• Serotonin: Mood, sleep, appetite 

• Dopamine: Reward, pleasure, motivation 

Cross tolerance

when one builds up a tolerance for one drug while also building up a tolerance for another drug in the same or a chemically similar class of drugs.

a phenomenon that occurs when tolerance to the effects of a certain drug produces tolerance to another drug (e.g., a person who drinks heavily may require higher doses of a benzodiazepine like lorazepam to obtain sufficient antianxiety effects).

Screening, brief intervention, and referral to treatment (SBIRT) 

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use and dependence on alcohol and drugs. This is an IOM-recommended strategy for community health care. It consists of three parts: 

• 1. Screening: the patient is assessed for risky substance use behaviors. 

• 2. Brief intervention: the health care professional provides feedback and advice. 

• 3. Referral for treatment: referrals are provided to brief therapy or additional treatment 

Antidote to treat inhalant toxicity

• Support affected systems 

• B12 and folate may help neurological symptoms

Signs of chemically impaired nurse

Frequent absences, mood swings/isolation, and incorrect med counts